Insist that you not visit family unless accompanied by someone approved by the alienating influence?

Require you to maintain contact (by phone/text, for example) with the alienating influence during family visits?

Try to isolate you from longtime friends as well as family?

Offer you a reward of any kind (not necessarily money) for obedience to them?

Entice you with sex, either with them or with someone else?

Interfere with your decision-making process regarding major life choices, such as moving away from home, selecting a college, choosing a job, getting married?

Require you to get their advice/permission before making key decisions?

Insert themselves into your life as the go-to person for direction on all things from emotional issues to finances?

Try to convince you that your parents were controlling and/or that your relationship was unhealthy?

5. What kind of lifestyle changes did you make for the sake of the alienating influence? (Choose all that apply.)

Severed relationships with friends

Severed relationships with family

Left home

Quit school

Gave up a favorite activity. Please specify:

Altered my belief system

Turned over savings/other source of income

Underwent a radical change in personality (for example, you became secretive, distant, and/or fearful of people you used to be close to)

Underwent a radical change in appearance

Other. Please specify:

6. What was done about the situation? (Choose all that apply.)

My family retrieved me at my request

My family retrieved me without my request

My extended family or friends reached out to me

School officials reached out to me

The police or other law enforcement official reached out to me

A lawyer reached out to me

A court official intervened

A member of the clergy reached out to me

A mental health professional or other helping professional reached out to me

A legislator or other government official reached out to me

My family tried to reason with the alienating influence

Nothing.

Other. Please specify:

7. Which statement best describes the current status of your situation?

I am in regular contact with my family member; our relationship is back to normal.
I have some contact with my family member, but our relationship is not back to normal.
There is no contact between me and my family member.

8. How old are you now?

16 or under
17-21
Over 21

9. How long did the alienation last/how long has it been going on?Duration:

10. May we contact you? If so, please enter your name and an email address or telephone number below:

Email:

Phone:

Name:

"The family is the natural and fundamental group unit of society
and is entitled to protection by society and the State."

— Article 16.3, Universal Declaration of Human Rights of the United Nations